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Legal Brief Outlines Policy Implications of CMS’ Final Rule

May 11, 2022 by Alexa Hornbeck
Legal Brief Outlines Policy Implications of CMS’ Final Rule
HHS Secretary Xavier Becerra tours health care facilities. (Courtesy of Flickr)

legal brief published on Tuesday by the law firm Ropes & Gray outlines the final rule for Medicare Part D and Medicare Advantage beneficiaries released by the Centers for Medicare and Medicaid Services on April 29, 2022.

CMS estimated the final rule will save beneficiaries $26.5 billion and increase manufacturer and government spending by $16.8 billion and $46.8 billion.


According to the legal briefing, the final rule could also have several effects on the Medicare Part D market, including enhancing predictability of cash flow for pharmacies and reducing out-of-pocket prescription drug costs for certain Medicare Part D patients enrolled at the pharmacy counter. This would lead Part D plan sponsors to raise premiums even as they compete for beneficiaries, and reduce manufacturers’ coverage gap discount payments as fewer beneficiaries enter the coverage gap phase.


The brief also illustrates how the final rule might affect Medicare Part D stakeholders, including plan sponsors, pharmacies and beneficiaries. CMS expects pharmacies, manufacturers and beneficiaries to benefit from the rule, while Part D sponsors would not. CMS also estimates a one-time administrative cost of approximately $1.4 million for Part D sponsors to implement necessary software updates to CMS data reporting. 


Alexa can be reached at [email protected]

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